Olle Hagnell

Are we entering an age of melancholy? Depressive illnesses in a prospective epidemiological study over 25 years: the Lundby Study, Sweden

The Lundby cohort consists of all inhabitants in a delimited area in Sweden studied in 1947 by Essen-Möller, then by Hagnell in 1957, and by Hagnell & Ojesjö in 1975. It has been claimed that depressive disorders have increased during the sixties and seventies. In order to examine this hypothesis on a normal population (the Lundby Study), comparisons were made of the incidence figures for depression during the periods 1947-57 and 1957-72, and during the five 5-year intervals within the period.

Prevalence and Incidence of Senile and Multi-Infarct Dementia in the Lundby Study: A Comparison between the Time Periods 1947–1957 and 1957–1972

In a recent Lundby paper, based on the original 1947 Lundby cohort [Hagnell et al., 1983], we reported a diminishing trend in the incidence of both senile and multi-infarct dementia from the first period of study 1947-1957 to the second, 1957-1972. In the present study we use the total Lundby population, including those who entered the Lundby project in 1957, as a basis for our calculations. The findings indicate no statistically significant changes in the prevalence and incidence of senile and multi-infarct dementia during the observation period 1947-1972.

Does the Incidence of Age Psychosis Decrease

2,550 persons from a geographically delimited area in Sweden were examined and described by a team of 4 psychiatrists in 1947. Mental disorders, personality traits, social factors, etc. were recorded

Salutogenic childhood factors reported by middle-aged individuals. Follow-up of the children from the Lundby study grown up in families experiencing three or more childhood psychiatric risk factors.

This study is salutogenic (=causes of health), focusing on factors which corresponded to good mental health in subjects who had been exposed to at least three child psychiatric risk factors when growing up. The material was drawn from a prospective, longitudinal population study on mental health, the Lundby Study, which was performed in three waves in 1947, 1957 and 1972. In 1988/89, 148 individuals then 42–56 years of age, were re-visited and interviewed about their life span experiences. Factors previously found to increase stress resilience in children and adolescents were identified. The personal dispositions during childhood found to be associated with adult positive mental health were childhood positive self-esteem, successful coping, internal locus of control and intellectual capacity. Childhood family factors, such as trusting relations with a parent and shared values, were also important. Antonovskys sense of coherence model can be used to explain the mechanisms by which the different variables can lead to health through increasing an individuals capacity for comprehensibility, manageability and meaningfulness, the three concepts of sense of coherence.

Childhood vulnerability and adult invincibility

This study is salutogenic, focusing on the people who cope successfully with the handicapping background of a high‐risk childhood. Of those aged 0–15 in 1947 in a total population survey of 2 Swedish parishes, 221 persons with 3 or more childhood psychiatric risk factors were identified. Personal interviews were conducted with 148 of them in 1988–1989. Four measures were used: the Sense of Coherence Scale, the Symptom Distress Checklist, the Quality of Life Scale, and a qualitative overall measure of health status using all interview material. Data analysis focuses on stressing the considerable proportion who managed to overcome their handicapped backgrounds. The sense of coherence is proposed as a powerful explanatory variable in such success.

Coping with life span crises in a group at risk of mental and behavioral disorders: from the Lundby study.

The subjects belong to a prospective, longitudinal population study on mental health, the Lundby study, performed in 1947, 1957 and 1972. In 1988–1989. 148 individuals, then 42–56 years of age, raised in families with at least 3 risk factors for mental or behavioral disorders, were interviewed about their life span coping style. Twenty‐two coping mechanisms were rated; optimism, substitution, wishful thinking, problem‐solving, planning, self‐reliance, humor, acceptance, resignation, social support, comparison with others, religion, catharsis, self‐criticism, value reinforcement, alcohol and drug consumption, professional help, endurance, information‐seeking, isolating activity, magic and minimizing. Together they contributed statistically significantly to mental health (explained variance 24%) and quality of life (explained variance 28 %). Problem‐solving, social support and optimism were frequently used and were statistically associated with positive mental health and lower frequencies of some mental disorders. Sense of coherence, a personal disposition factor, was also statistically associated (explained variance 22%) with the combined coping mechanisms.

INTELLIGENCE AND TEMPERAMENT AS PROTECTIVE FACTORS FOR MENTAL HEALTH. A CROSS-SECTIONAL AND PROSPECTIVE EPIDEMIOLOGICAL STUDY

The Sjöbring system of personality dimensions measuring intellectual capacity, activity, impulsivity and sociability was used to study possible “salutogenic” (i.e. causes of health) effects. The study comprised 590 subjects investigated in 1947, 1957, 1972 and 1988–1989 in the Lundby project, an epidemiological study in Sweden. Psychiatric diagnoses were made in 1947, 1957 and 1972. Mental health was estimated in 1988–1989 using the concept “love well, work well, play well and expect well”. The Sjöbring dimensions were clinically assessed in 1972. Both in the concurrent study in 1972 and in the prospective study in 1988–1989 “super capacity” (high intellectual function), “super validity” (high activity level) and “super solidity” (low impulsivity) were statistically associated with lower frequencies of certain psychiatric diagnoses and a higher frequency of positive mental health. These variables are proposed to increase coping capacity, and therefore increase stress resilience.

Does it make sense to do repeated surveys? – the Lundby Study, 1947–1997

Objective:  To describe the Lundby Study and the difficulties in doing repeated surveys.

Suicide in the Lundby Study: a Comparative Investigation of Clinical Aspects

28 cases of suicide committed in a Swedish population subjected to repeated psychiatric investigations are described. Two groups of controls were selected from the same population: sex- and age-matched living persons (normal group) and sex-matched persons who had died from organic disease at ages corresponding to those at which the individuals in the suicide group had taken their lives (deceased group). The three groups were compared concerning clinical circumstances regarded to have been of importance for the final suicidal act. Interest was focused on events that had occurred during the year prior to suicide. Psychiatric disorders were diagnosed in 93% of the suicide group, in 60% of the deceased group, and in 32% of the normal group. Depression was the main diagnosis (50%) in the suicide group, organic brain syndrome in decreased and normals. Medical advice was sought more often (75%) by the suicide group than by normal controls (34%) and about equally often as by the deceased control (84%). 10 of the suicide persons with depressive illness had never seen a psychiatrist.

Current trends in the incidence of senile and multi-infarct dementia

SummaryOrganic brain syndromes among the elderly have been studied prospectively in a total population during the 25-year period 1947–1972. The population (2,550 persons) originates from a geographically delimited area in southern Sweden (Lundby). The original population has been followed for 25 years irrespective of domicile. A comparison of incidences for the first 10-year period (1947–1957) and the second 15-year period (1957–1972) shows a decrease in organic brain syndromes in the population concerning multi-infarct as well as senile dementias.ZusammenfassungProspektive Studien über organisch bedingte Hirnsyndrome in hohem Alter wurden an einer Gesamtbevölkerung in einer Periode von 25 Jahren 1947–1972 durchgeführt. Die Bevölkerung (2550 Personen) stammt aus einem geografisch abgegrenzten Gebiet in Südschweden, hier Lundby genannt. Unabhängig vom Wohnsitz wurde die ursprüngliche Bevölkerung über 25 Jahre beobachtet. Ein Vergleich der Inzidenzen zwischen der ersten 10-Jahresspanne (1947–1957) und der zweiten 15-Jahresspanne (1957–1972) zeigt eine Abnahme von organisch bedingten Hirnsyndromen betreffend Multi-infarkt Demenz sowie Senile Demenz in der Bevölkerung.